Lymphovenous Anastomosis for Treating Lymphedema in IgG4-Related Disease

Immunoglobin G4-related disease (IgG4RD) is a multi-organ immune-mediated condition, and lymphoplasmacytic infiltration is one of the main pathologic features.(1,2) Lower extremity lymphedema is likely to occur if the infiltration involves multiple inguinal lymph nodes and thus disrupting lymphatic transport. Lymphovenous anastomosis (LVA) is a surgical procedure used to treat obstructive lymphedema in extremities(3,4) or in the head and neck area.(5) It basically reroutes the obstructed lymph flow into patent venous system by making microsurgical anastomosis between lymphatic duct and vein over the swollen area. Herein, we reported a patient with recalcitrant lower extremity lymphedema caused by IgG4RD, whose lymphedema subsided after being treated with LVA.